Marina Ulla

Prenatal Diagnosis of Skeletal Dysplasias: Contribution of Three-Dimensional Computed Tomography

Objective: To describe the contribution of 3-dimensional computed tomography (3D-CT) in the prenatal diagnosis of skeletal dysplasias (SD) in a cohort of patients with inconclusive diagnosis by ultrasound (US). Methods: Between May 2007 and February 2010, six pregnant women with suspected fetal SD on US examination but with no specific diagnosis were studied with 3D-CT. The images were evaluated by a multidisciplinary team who proposed a likely diagnosis. Further postnatal workup included clinical and radiological evaluation in all cases. Prenatal and postnatal diagnoses were compared. Results: The use of 3D-CT provided a precise diagnosis confirmed postnatally in 5/6 patients. These included osteogenesis imperfecta type II (n = 2), osteogenesis imperfecta type III (n = 1), chondrodysplasia punctata (n = 1) and thanatophoric dysplasia type I (n = 1). A precise diagnosis could not be made in 1 case – either pre- or postnatally. Conclusion: Prenatal 3D-CT contributed to the diagnosis of the specific fetal SD in the majority of these cases. 3D-CT may have a complementary role to US where fetal SD is suspected, but no specific diagnosis can be made using US alone. Further studies on clinical performance and risk-benefit analysis are needed.

Nuevo Metodo de Regeneracion hepatica

Postoperative liver failure (PLF) is the most feared and serious complication after extensive liver resections. We present an innovative surgical technique for the treatment of a patient with colorectal cancer and initially unresectable liver metastases. After completing neoadjuvant chemotherapy, it was decided to perform simultaneous surgery. A left hemicolectomy and cleaning of the metastases in the left liver was performed. As the future liver remnant (FLR) was insufficient, it was decided to perform an in situ liver split and a right portal vein ligation. On the 6(th) day after the surgery a volumetric CT showed an increase greater than 40% of the FLR. The right hepatectomy was completed and the patient was discharged on the 11(th) day after surgery. The technique induced a rapid growth of the FLR, exceeding that reported using portal occlusion. If these findings are corroborated in future studies, this revolutionary technique could enable surgery to be performed in two stages on patients with initially unresectable liver disease during the same hospital admission and without PLF.

Elevated gastric lesions: virtual gastroscopy

With the development of multidetector computed tomography and the improvement in the capabilities of workstations, the use of high-quality three-dimensional reconstructions and virtual images can be applied to organs other than the colon such as the stomach. As a noninvasive technique, virtual gastroscopy represents an alternative to conventional endoscopy for the detection of elevated lesions. Findings of this technique are illustrated.

Direct 64-row MDCT venography in the diagnosis of an inferior vena cava leiomyosarcoma

We report the usefulness of a technique called direct-MDCT venography in the diagnostic workup of a patient with an inferior vena cava leiomyosarcoma. The technique consists in the injection of contrast agent through both lower limbs achieving maximum enhancement in the inferior vena cava. Images are similar to those of the gold standard conventional cavography. To our knowledge, this is the first description of the direct-MDCT imaging appearance of an inferior vena cava leiomyosarcoma.

Early Experience with the AMPLATZER Vascular Plug IV for the Occlusion of Pulmonary Arteriovenous Malformations

The recent generation of AMPLATZER Vascular Plug (AVP; ie, the AVP IV) was used for the occlusion of eight pulmonary arteriovenous malformations (PAVMs) in five patients. A treatment was considered successful when there was a reduction or disappearance of the aneurysmal sac. At a mean follow-up of 20.1 months, no recanalization of PAVMs was observed on multidetector computed tomographic angiography. This shows the AVP IV to be safe and effective as an embolic device to occlude PAVMs.